As the well known baby boomer generation surges toward retirement age, the issue becomes more significant each day of how this generation of 78 million seniors will be able to remain as independent as possible while increasingly burdened by the onset of multiple, chronic, medical conditions and a decline in cognitive abilities. Concurrent with the dramatic increase in the numbers of seniors with disabling conditions, the Medicare system is expected continue to reduce services due to economic conditions and budgetary constraints. Additionally, the rate of demand for professional health care and direct-care workers is expected to dramatically outpace supply over the next decade. Consequently, community-based care of seniors with disabilities will be more and more in the hands of the individuals themselves and their family caregivers receiving limited guidance from professional care organizations. One of the biggest issues that face home care agencies is the lack of consistency in care giving caused by inexperienced or changing caregivers and the high cost of home visits to monitor health plan compliance. The result of these inadequacies is that all too often many seniors with disabilities are prematurely moved to more restrictive, expensive and institutional living environments that would not be necessary if home health care was provided in a more consistent manner with predictable quality. One approach to help avoid premature removal from community living arrangements is to use new technologies to help improve self-directed personal health care compliance along with remote health monitoring tools for professional caregivers to enable seniors to "age in place" while maximizing quality of care for seniors with disabilities. Therefore, in this project we will build on the successful results of Phase I to develop HealthCare Manager, a personal healthcare support system using powerful mobile computer devices to make it easier for seniors to perform personal health care activities, such as knowing when and how to take medications or comply with therapy routines, and to track health care actions that have been completed. This innovative approach will help enable elderly individuals to "age in place," maximize the consistency and quality of self-care, and avoid premature relocation to institutional settings. This approach uses new technologies to help seniors engage in self-directed personal health care while also employing remote health monitoring tools for caregivers and health professionals. A prototype system was developed in Phase I and tested for usability with 32 seniors by AbleLink's project partner, the University of Colorado's Gerontology Center. The results provided strong preliminary support demonstrating the utility and usability of the HCA system. For example, when using the HCA technology seniors performed a novel task at a 99.1 percent accuracy rate, with no prior knowledge of how to complete the specific health care task. Additionally, seniors using the HCA system were able to respond to the time-based reminders to perform a specific health care task 100 percent of the time, even with the mild distraction of watching a nature film during the testing period. PUBLIC HEALTH RELEVANCE: The objectives of this project are to research, design and develop HealthCare Manager (HCM), a software system for improving consistency and quality of implementing home health care regimens for seniors living in their own homes. This relates to the mission of NIH by providing a support tool that will enable seniors to perform personal health care tasks more consistently and accurately, thus promoting individual health and quality of life.